Retinopathy of Prematurity

What is retinopathy of prematurity?

Retinopathy of prematurity (ROP) is an eye condition that can affect babies born prematurely (before they reach full term) or those who weigh less than 3 pounds at birth.

ROP happens when abnormal blood vessels start to grow in the retina, which is the light-sensitive tissue at the back of the eye. Some babies with ROP might have mild symptoms and get better on their own, while others may need treatment to protect their vision and prevent blindness.

What are the stages of ROP?

ROP is divided into five stages, which help healthcare professionals keep track of how serious the condition is. The stages go from stage 1 (mild) to stage 5 (severe):

  • Stages 1 and 2 — Babies in these stages usually improve without any treatment and can end up with healthy vision. Doctors will keep a close eye on them to see if their ROP gets worse.

  • Stage 3 — Some babies at this stage might recover without treatment and have normal vision, but others may need help to stop the abnormal blood vessels from damaging the retina and causing retinal detachment (a serious condition that can lead to vision loss).

  • Stage 4 — Babies in stage 4 have partially detached retinas and need medical treatment.

  • Stage 5 — In stage 5, the retina is completely detached. Even with treatment, babies in this stage might still face vision loss or blindness.

Stages 4 and 5 are especially critical. Babies in these stages often need surgery, but even with treatment, they might still have vision problems. That’s why doctors usually start treatment during stage 3.

It’s also important to note that babies at any stage can quickly get worse and need treatment. So, make sure your baby goes to all their follow-up appointments. Early detection and treatment of ROP are the best ways to lower the risk of serious complications.

What are the symptoms of ROP?

There aren’t any obvious signs of ROP that are easy to spot. In more advanced cases, the retina might partially or completely detach from its normal position, which can lead to vision loss and blindness.

If your baby has had ROP that caused damage, you might notice some of these signs later on:

  • Their eyes may wander, shake, or move in unusual ways

  • They might not track objects with their eyes

  • Their pupils could look white

  • They may have trouble recognizing faces

Babies who have had ROP are also at a higher risk of developing other eye problems as they grow, such as:

If your child had ROP when they were younger, it’s really important to make sure they get regular checkups and eye exams. Catching and treating eye issues early can help protect your child’s vision as they grow.

Is my baby at risk for ROP?

Babies are more likely to develop ROP if they are born before 30 weeks of gestation or weigh less than about 3 pounds at birth. If your baby falls into this risk category, an eye specialist will check for ROP.

Additionally, babies are at a higher risk if they have:

  • Breathing problems (especially if they need a lot of oxygen therapy)

  • Infections or other medical issues that are common in premature infants, like heart, lung, or brain complications

What causes ROP?

Usually, the blood vessels in the retina start developing around the fourth month of pregnancy and finish growing around the due date, which is about 9 months of gestation.

When a baby is born very early, these blood vessels might not develop properly. As a result, the retina can start to create new, abnormal blood vessels, a process called retinal neovascularization, or NV.

These abnormal blood vessels can grow in the wrong way. Since they’re attached to the retina, if they grow too far in the wrong direction, they can pull the retina away from the back of the eye, leading to retinal detachment.

How will my baby’s doctor check for ROP?

If your baby is at risk for ROP, they’ll need a dilated eye exam a few weeks after birth, usually between 4 to 9 weeks after delivery. Be sure to ask your doctor when your baby should have their eye exam before you leave the hospital.

During the exam, the eye specialist will use eye drops to dilate (widen) your baby’s pupils. The doctor will carefully check every part of your baby’s eye for any issues, focusing especially on the retina.

Based on what they find during the initial exam, the eye doctor will decide if your baby needs follow-up exams. If more checks are needed, the doctor will schedule additional eye exams every 1 to 3 weeks until they’re no longer worried about the risk of retinal detachment.

It’s really important to stick to your baby’s follow-up exam schedule. This way, the doctor can catch ROP early and start treatment right away.

What's the treatment for ROP?

Many babies with ROP have mild cases and get better without any treatment. However, some babies do need treatment to stop ROP from getting worse. Early treatment is key to protecting your child’s vision. Treatment options include:

  • Laser treatment. Babies with advanced ROP might need laser therapy on the outer parts of the retina. This can help prevent ROP from worsening and protect your child’s vision.

  • Injections. Doctors can also give medications called anti-VEGF drugs directly into your baby’s eye. These drugs help stop the growth of abnormal blood vessels.

  • Eye surgery. There are two types of surgeries for babies with partially or completely detached retinas (stages 4 or 5):

    • Scleral buckle surgery. The surgeon places a flexible band around the sclera (the white part of the eye) to support the detached retina until the eye grows normally, after which the band will be removed.

    • Vitrectomy. The surgeon makes small openings in the eye wall to remove most of the vitreous (the gel-like substance filling the eye) and replaces it with a saline solution. They’ll also remove any scar tissue on the retina and may do laser treatment to secure the retina in place.

    The goal of ROP surgery is to prevent the condition from getting worse and to avoid blindness. Even with surgery, some babies with ROP might still experience vision loss or blindness.